Management of ulcerative colitis: summary of updated NICE guidanceBMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5897 (Published 28 October 2019) Cite this as: BMJ 2019;367:l5897
- Omnia Abdulrazeg, technical analyst1,
- Bernadette Li, technical adviser in health economics1,
- Jenny Epstein, consultant paediatric gastroenterologist2
- on behalf of the Guideline Committee
- 1National Institute for Health and Care Excellence, Manchester, UK
- 2Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK
- Correspondence to O Abdulrazeg
What’s new in the guidance
New recommendations on inducing remission in people with mild to moderate ulcerative colitis
Classifying the extents of ulcerative colitis by grouping left sided disease and proctosigmoiditis, to more closely reflect current practice
In people with proctitis, proctosigmoiditis, or left sided disease, offer a topical aminosalicylate as first line treatment
In people with extensive disease, offer a topical aminosalicylate and a high dose oral aminosalicylate as first line treatment
Courses of oral corticosteroids should be time limited (normally 4-8 weeks depending on the steroid)
Ulcerative colitis is a chronic inflammatory disease of the rectum and colon characterised by mucosal inflammation, resulting in symptoms of diarrhoea (both soft stool and an increased frequency of defecation), rectal bleeding, an urgent need to defecate, and abdominal pain.
The condition usually affects the rectum and a variable extent of the colon proximal to the rectum. Inflammation of the rectum is referred to as proctitis, and inflammation of the rectum and sigmoid as proctosigmoiditis. Left sided colitis refers to disease involving the colon distal to the splenic flexure. Extensive colitis affects the colon proximal to the splenic flexure, and includes pan-colitis, where the whole colon is involved.
The most widely used drugs for inducing remission in people with mild to moderate ulcerative colitis are aminosalicylates and corticosteroids. Choice of treatment depends on the extent of disease (proctitis, proctosigmoiditis, left sided colitis, extensive colitis), mechanism of action, route of administration, site and mechanism of drug release, dose, duration, cost of treatment, and patient preference.
This article summarises recent recommendations from the update of the National Institute for Health and Care Excellence (NICE) guideline for the management of ulcerative colitis in children, young people, and adults.1 The update focuses on inducing remission in people with mild to moderate ulcerative colitis. All other areas of the guideline, such …